感觉是由肺往下转移至 肝、肾,考虑1.腺癌.2.恶性间皮瘤.3.问病史,最早出现症状的是哪个脏器.

A very interesting and challenging case, but really good quality photos. I would make some guesses.

1. Morphologically I am most impressed with the epithelioid spindle cells, inflammary cell background and cleft like spaces, many cells with clear cytoplasm and hobnail cells, not terribly high grade nuclei, infiltrating the renal tubules

2. Wide differentiatial diagnoses: carcinoma (RCC most likely); sarcoma (angiosarcoma and others)

3. If masses in the liver, kidey and lung at the same time, by frequency kidney as the primary site is much more common than other combinations.

Thanks!

胞浆透明，细胞巢间可见丰富的血管，首先考虑肾脏的透明细胞癌

 上级医院组化结果及诊断

CK +  Vim +  EMA+   CD10 -   CK34βE12 +  CEA-  CK19+

Bellini集合管癌